metronidazole

Antibiotic resistance and adverse effects pose significant challenges to the effectiveness of Helicobacter pylori eradication therapies, such as clarithromycin-based triple therapy. Alternative treatments, including bismuth quadruple therapy, are effective in cases of clarithromycin resistance. Levofloxacin and metronidazole-based triple therapy have demonstrated high success rates with fewer side effects, making it a preferred option following clarithromycin treatment failure.

This study aimed to evaluate the effectiveness of levofloxacin and metronidazole in eradicating H. pylori among patients with chronic epigastric pain in Zakho, Iraq. It also assessed the accuracy of diagnostic tests, patient history, and post-treatment confirmation of eradication.

A prospective study was conducted involving 100 patients with chronic epigastric pain at Zakho General Teaching Hospital. Diagnosis was performed using the fecal antigen test, urea breath test (UBT), and endoscopy with biopsy. Patients were treated with a 14-day regimen comprising levofloxacin, metronidazole, and either esomeprazole or pantoprazole.

Of the 100 participants, 66% were female, with a mean age of 37.85 years. The fecal antigen test, performed on 60 patients, showed a positivity rate of 96.5%, while the UBT, conducted on 40 patients, revealed a positivity rate of 97.5%. The highest infection rate was observed in the 51 - 60 age group. The 14-day levofloxacin and metronidazole regimen achieved a 99% eradication rate with minimal side effects.

This study underscores the high efficacy of levofloxacin and metronidazole-based therapy for H. pylori eradication. It highlights the importance of non-invasive diagnostic methods, enhanced patient follow-up, and international collaboration to achieve optimal treatment outcomes.

Triple antibiotic paste (TAP) is the commonly used intracanal medicament against Enterococcus faecalis. Amoxicillin clavulanate paste (ACP) is recommended as a “fall‑back” antibiotic when traditional dental antibiotics fail. Literature comparing the antimicrobial efficacy of TAP and ACP in eradicating E. faecalis from the root canal system is sparse; hence, this in vitro study was conducted to evaluate and compare the antimicrobial efficacy of TAP and ACP as an intracanal medicament for endodontic treatment of single‑rooted permanent teeth against E. faecalis.

This in vitro, experimental study evaluated 60 root samples obtained from extracted single‑rooted human permanent teeth. The canal diameter was enlarged and subsequently infected with E. faecalis for 21 days. Four groups of the contaminated samples were treated with TAP, ACP, calcium hydroxide (positive control), and saline (negative control), respectively. Dentinal shavings were collected at the end of the 1st, 7th, and 10th day and inoculated in agar plates. The number of colony‑forming units was determined, and the data were statistically analyzed using the Kolmogorov–Smirnov and Shapiro–Wilks test. P <0.05 was considered statistically significant.

The mean number of E. faecalis colony counts across all 3 test days demonstrated that TAP exhibited the highest inhibition of bacterial growth, followed by ACP which is not statistically significant (P = 1.00).

Considering the limitations of this in vitro study, the findings suggest that ACP could be an effective alternative intracanal medicament to TAP for endodontic therapy.

Infections are an important cause of morbidity and mortality after hysterectomy. Here, we aimed to investigate and evaluate the beneficial effects of metronidazole vaginal gel on the rate of surgical site infections in women undergoing elective abdominal hysterectomy.

This is a randomized prospective, double‑blind controlled clinical trial performed in 2020 in Isfahan on 108 candidates for elective hysterectomy. At the beginning of the study, we completed a checklist of the patient’s characteristics (patient age, body mass index [BMI], and history of medical conditions such as diabetes, hypertension, anemia, and immune deficiency) and the cause of hysterectomy. All patients were randomized into two groups. The first group received a lubricant vaginal gel single dosage, and the second group received a 0.75% metronidazole vaginal gel single dosage the night before surgery. Patients were visited up to 6 weeks after surgery, and the frequency of infection at the surgical site was determined.

The rates of infection were lower in patients who received metronidazole vaginal gel (5.8%) compared to the control group (11.6%) (P = 0.03). Patients with an estimated blood loss volume of more than 500 mL had higher rates of infection (13.46%) compared to patients with a bleeding volume of fewer than 500 mL (1.9%) (P = 0.001). We also found that patients with diabetes (13.5%) and patients with BMI more than 30 kg/m2 ( 13.5%) had higher rates of infection compared to patients without diabetes (5.8%) and patients with BMI <30 kg/m2 (11.5%) (P = 0.001 for both). Patients with higher hospitalization duration had higher infection rates (P = 0.009).

Administration of a single dosage of metronidazole vaginal gel before abdominal hysterectomy may reduce surgical site infection and have clinical values.

Trichomoniasis caused by Trichomonas vaginalis is considered one of the most important worldwide non-viral sexually transmitted infections. The remaining clinical symptoms of the disease after treatment with metronidazole confirm the presence of metronidazole-resistant strains.

Therefore, the present study aimed to investigate the inhibitory effect of the extract of the root and leaf of the Sophora alopecuroides plant on the growth and inhibition of the growth of T. vaginalis parasite.

Aqueous and alcoholic extracts of S. alopecuroides plant roots and leaves with concentrations of 0.5, 1, 2, 4, and 5 mg/mL, as well as metronidazole were exposed to 105 parasites and mouse macrophage cells in 24 and 48 hours. To determine the toxicity of the extract on the cells, mice peritoneal cells were used for the 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyl-2H-tetrazolium bromide test. The half-maximal inhibitory concentration and 50% cytotoxic concentration values were evaluated by PRISM GraphPad software, and analysis of variance and t test were employed for statistical comparisons by SPSS-23.

The aqueous-alkaline compounds of the root of the S. alopecuroides plant demonstrated a promising effect on inhibiting parasite growth, but the therapeutic index of the aqueous extract of its leaves was less effective than the rest of the extracts and metronidazole. After 24 hours, at a concentration of 2.5%, the aqueous extract of the root had the most effect with 69.4%, and the aqueous extract of the leaf had the least effect with 34.68% of growth inhibition. However, none of the extracts had a greater inhibitory effect than metronidazole, but after 48 hours, the effect of the extract caused more inhibition due to time.

Overall, the aqueous and alcoholic extracts of the leaves and roots of the S. alopecuroides plant had suitable anti-trichomonas effects. In addition, the aqueous leaf extract had a good effect with the least toxicity. Considering that this research was performed for the first time, to generalize the results, extensive research is needed in in vivo conditions.

Some studies have shown that giardia infection is associated with some abdominal symptoms. The aim of this study was to determine the relationship between giardia duodenalis infection and irritable bowel syndrome (IBS). In this clinical trial study, 60 patients with non-constipation predominant IBS based on Rome III criteria were enrolled in the study. 30 patients with giardiasis who were diagnosed with stool Eliza as patients, and 30 other patients who did not have giardiasis as control enrolled to study. All patients were treated with 250 milligrams of metronidazole TDS for 5 days. Abdominal symptoms including abdominal pain, bloating, and diarrhea were determined and compared in both groups before and after treatment. The mean age and sex distribution of the two groups were similar (P>0.5). The pain, bloating, and diarrhea severity before treatment with metronidazole were not significantly different in the two groups. The pain and bloating and diarrhea severity in both groups significantly decreased after the treatment period, but reductions were significantly higher in the case group (P<0.001 and P<0.001 P<0.001, respectively). The mean score of global symptoms before treatment in both case and control groups was similar. (P=0.88), but after treatment it was 4.85±2.18 (P<0.001) and 10.48±2.14 (P<0.001) respectively and the difference between the two groups was significant (P<0.001). The recovery percentage was 0.61±0.16 in the case group and 0.14±0.17 in the control group (P<0.001). Giardia infection in patients with IBS seems to play a significant role in clinical manifestations of non-constipation IBS and treatment with metronidazole can improve these symptoms significantly.

 The current evaluation was planned to study the effect of vitamin D on improving bacterial vaginosis in premenopausal women with vitamin D deficiency.

 This study was an open-label clinical trial. Forty premenopausal vitamin D deficient women with bacterial vaginosis enrolled in this study. Patients received metronidazole tablet 500 mg twice daily for seven days in both groups. In the vitamin D group, patients also received 50000 IU per day for five days.

 Fourteen days after completion of the study, the number of patients complaining of malodor vaginal discharge, vaginal itching, and discharge discoloration was significantly lower than that in the control group. Regarding the laboratory results, in the vitamin D group, the numbers of Gardnerella vaginalis, gram-negative bacilli, and clue cells in the smear of vaginal secretions were significantly less than in the control group (p<0.05). Furthermore, none of the patients had a positive whiff test after treatment in the vitamin D group (p<0.05). Fourteen days after the completion of the study, the plasma level of 25-OH vitamin D in the vitamin D group was significantly higher than that in the control group. However, the short course of high-dose vitamin D therapy did not increase the plasma concentration of 25-OH vitamin D to the average level.

 Vitamin D supplementation can improve the therapeutic response to metronidazole in vitamin D deficient women with BV. However, large-scale double-blind, randomized clinical trials must confirm this finding.

The use of antibiotics with or without prescription is increasing worldwide. With certain limitations, metronidazole (MTZ) is extensively used as an antibacterial and antiparasitic drug. Derivatives of 1,2,4-oxadiazole (ODZ) are used to modify the chemical structure of drugs. The present study aimed to synthesize new MTZ-ODZ derivatives that could potentially lead to new medications.  The reaction of MTZ with ethyl chloroacetate and potassium carbonate anhydrous was used to produce compound 7. This compound was treated with hydrazine hydrate in methanol to obtain compound 8. Carbon disulfide and potassium hydroxide were then added to obtain compound 9, which was then mixed with various α-haloketones to obtain compounds 10a to 10f. Subsequently, the structures of the new MTZ-ODZ derivatives were determined. All new compounds exhibited excellent activity against all tested organisms. The synthesized compounds showed a significant radical scavenging activity. The IC50 value for compounds 10a, 10b, 10c, 10d, 10e, and 10f was 70.42±0.15, 70.52±0.54, 85.21±0.85, 80.10±0.46, 82.52±0.13, and 70.45±0.12 g/mL, respectively. In terms of antigiardial activity, the IC50 value for compounds 10a,10b, 10c, and 10d ranged from 1.31±0.11 µM to 2.26±0.49 µM. In contrast, the IC50 for MTZ was 3.71±0.27 µM. Compound 10f showed the highest antigiardial activity with an IC50 value of 0.88±0.52 µM.  Most of the MTZ-ODZ derivatives showed high radical scavenging activity in the benzene ring due to the activation of certain groups, such as OCH3, NO2, and OH. The results suggest that the newly synthesized compounds could be used as an antiparasitic drug.

Fasciola hepatica is a zoonotic liver trematode that usually causes infection in cattle and sheep, and is transmitted to humans by consuming water and aquatic plants contaminated with metacercaria. The detection of Fasciola eggs in stools, serological evaluation and radiological evaluation are essential for diagnosis. Triclabendazole is the first-line therapy for fascioliasis. However, as triclabendazole is not an easily accessible drug in countries such as Turkey, it reveals a quest for alternative therapies. In this report, we present a 10-year-old boy with fascioliasis successfully treated with a course of metronidazole 1.5 g/ day for 3 weeks in 2020. During the follow-up, eosinophilia and radiological findings completely recovered. Here we report a case of pediatric fascioliasis that was cured with metronidazole successfully.

 Coronavirus disease 2019 (COVID-19) has turned into a global public health crisis since the end of 2019. It may thus take years to develop new drugs, so evaluating the existing ones can play a key role in suppressing or even mitigating the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

 This study reflected on the effects of ivermectin (IVM) and metronidazole (MTR) vs. standard treatment protocols on symptoms, humoral immune responses, and outcomes of COVID-19 in hospitalized patients.

 This triple-blinded randomized controlled trial (RCT) of IVM and MTR vs. standard treatment protocols was conducted from February 2021 to May 2021. A total number of 107 participants were accordingly selected from all patients infected with SARS-CoV-2 and positive results for SARS-CoV-2 based on the reverse transcription-polymerase chain reaction (RT-PCR) or the computerized tomography (CT) scan results at three teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. In this RCT, several indicators, including some vital signs, biomedical parameter, length of hospital stay (LOS), and death, were considered the outcomes.

 A total number of 107 patients were recruited in this study. The results revealed that 10 patients (10.4%) expired during hospitalization. The mortality rate in IVM group (4.5%) was lower compared with MTZ (15.8%) and standard treatment (11.8%) (P = 169). After five days, the mean differences of lymphocyte and neutrophil counts differed significantly between groups (P = 0.020 and P = 0.029, respectively). But, other outcomes did not differ (P > 0.05).

 Based on this RCT, neither IVM nor MTZ could significantly affect COVID-19 patients’ recovery patterns compared with the standard treatment protocols. Hence, more studies are needed to test diverse combinations of immunological response triggering and anti-inflammatory drugs. Moreover, including and relying on IVM in clinical guidelines for COVID-19 should be cautioned and based on more evidence.

Co-processing is a process that manipulates available excipients to produce better functional excipients. 

This study aims to prepare a co-processed excipient from starch extracted from Dioscorea rotundata (WYS) and gum extracted from pods of Abelmoschus esculentus fruit (OKG). 

The co-processed excipients (CYG) were prepared by co-fusing WYS and OKG at concentrations of 99:1, 97:3, 95:5 to produce CYG1, CYG3, and CYG5, respectively. Then, they were evaluated for their flow and swelling properties. Metronidazole tablets (MT1, MT3, and MT5) were prepared by direct compression. Similarly, tablets containing reference excipients of CombiLac® (MTC) and Prosolv® (MTP) were prepared. The tablets were evaluated for uniformity of weight, crushing strength, friability, disintegration time, and in vitro release. Fourier Transform Infra-Red (FTIR) was used to monitor the interaction between the excipients and metronidazole.

CYG1, CYG3, and CYG5 have good flow; their swelling profile was between 170% and 200%, more than WYS (80%). FTIR spectra showed no interaction between the excipients and metronidazole. The crushing strength-friability ratio was 42.03>39.65>25.63 for MT3, MT5, and MT1, respectively. MT5 had a longer disintegration time (63.87 s) than MT1 and MT3, which were similar to that of MTC; however, MTP had the longest disintegration time (111.50 s). The disintegration efficiency ratio showed that CYG1 and CYG3 have better disintegration properties than Prosolv®. All the co-processed excipients produced robust tablets comparable to those of CombiLac®.

CYG can be exploited as a multifunctional excipient in preparing oral tablet formulations.

Removing the pathogenic microorganisms from the root canal system is the key to a successful endodontic therapy. This study aimed to evaluate the antibacterial efficiency of three antibacterial agents and a new combination against selected endodontic pathogens.

In this in vitro study, the efficacy of three different antibacterial agents namely clindamycin, metronidazole, doxycycline, and their com-bination (CMD) was evaluated against seven bacterial strains associated with endo-dontic infections to determine their minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). selective media were used to culture Candida albicans (C. albicans), Pseudomonas aeruginosa (P. aeruginosa), Escherichia coli (E. coli), Enterococcus faecalis (E. faecalis), Streptococcus mutans (S. mutans), Bacillus subtilis (B. subtilis) subsp. spizizenii, and Actinomyces actinomycetemcomitans (A. actinomycetemcomitans). All the tests were repeated in triplicate. The MIC and MBC values were reported as mean ± standard deviation. Data were analyzed by the Shapiro-Wilk test, the Kruskal-Wallis test, and Wilcoxon signed-rank test (P<0.05).

The intergroup comparisons of MIC for clindamycin versus CMD (P=0.036), metronidazole versus CMD (P=0.016), and doxycycline versus CMD (P=0.016) demonstrated significant differences. No other significant difference was noted (P>0.05). Intergroup comparisons of MBC for clindamycin versus CMD (p=0.036), metronidazole versus CMD (P=0.022), and doxycycline versus CMD (p=0.016) demonstrated significant differences. No other significant difference was noted (P>0.05).

CMD showed superior antibacterial efficacy than each individual antibiotic, and can be used effectively against the abovementioned endodontic patho-gens for their predictable elimination during endodontic therapy.

The purpose of this in vitro study was to investigate drug release kinetics and cytotoxicity of a novel drug delivery system for treatment of periodontitis.

This in vitro study addresses the fabrication of a polycaprolactone/ alginic acid‑based polymeric film loaded with metronidazole, as a basic drug in the treatment of periodontal diseases. Films were prepared by solvent casting technique. Four formulations with different percentages of drug by weight (3%, 5%, 9%, and 13%) were prepared. Drug release kinetics were investigated using ultraviolet–visible spectroscopy during (one week). Data were analyzed using repeated measures ANOVA. Cytotoxicity of drug‑loaded system extracts was evaluated by 3‑(4,5‑dimethylthiazol‑2‑yl)‑2,5‑diphenyltetrazolium bromide (MTT) assay using L929 cells after 24‑h incubation. The results were evaluated according to ISO standard 10993‑5 and assessed using ANOVA and Tukey’s tests at a significance level of P < 0.05.

All polymeric films showed a burst drug release followed by a gradual release. Drug release data were fitted well with the first‑order kinetic model in all drug‑containing formulations indicating that drug release is a fraction of remaining drug in the matrix. Drug release is mainly driven by diffusion of medium into the composite matrix. 3%wt metronidazole‑containing formulation exhibited the best MTT result.

The findings of this study supported the synthesis of drug‑loaded periodontal films with 3% metronidazole due to better biological properties along with the ability of acceptable drug release to eradicate anaerobic periodontal bacteria.

Metronidazole (MTZ) can decrease the levels of several cytokines. This research aimed at the investigation of the anti-inflammatory impact of MTZ in COVID-19. A randomized, single-blind clinical trial for comparing the anti-inflammatory effect of MTZ in two eligible groups of adult patients with lower respiratory tract involvement due to Covid-19 treated with a standard national method with or without MTZ was performed. Inflammatory markers were measured as the primary outcome in two groups. Oxygen saturation, length of hospital stays, and mortality of patients were evaluated as secondary outcomes. Among 44 patients with lower respiratory tract due to Covid-19, 20(45.5%) were randomly allocated in group A with the current standard treatment plus the MTZ tablet for 7 days orally and 24 (54.5%) in group B with the current standard treatment. The mean of ESR in group A was statistically significantly lower than that of group B on the seventh day (A: 38.25 ± 18.75 vs. B: 47.67 ± 26.41, p = 0.02). Moreover, the mean of IL6 diminished significantly in both A (p = 0.01) and B (p = 0.01) groups on the seventh day compared to the first day. The decrease of TNF was not significant in any of the groups A (p = 0.3) and B (p = 0.4) from the 7th day to the first day. No significant difference was not found between group A and group B groups on the CRP level (p = 0.1). Findings of this study showed the anti-inflammatory impact of MTZ in the patient with lower respiratory inflammation due to COVID-19.